Erectile dysfunction (ED) is a prevalent condition closely associated with systemic inflammation and metabolic disorders. The red cell distribution width to albumin ratio (RAR) is an emerging inflammatory marker; however, its relationship with ED remains poorly understood.
This study conducted a cross-sectional analysis of data from 3,950 participants in the National Health and Nutrition Examination Survey (NHANES) 2001-2004 cycle to evaluate the association between RAR and ED risk. A Multivariable logistic regression model was employed to assess the relationship between RAR and ED, while a generalized additive model (GAM) and dose-response analysis were utilized to explore potential nonlinear associations. Subgroup analyses were performed to investigate interactions with demographic and lifestyle factors.
Among the study population, 1,157 individuals reported a history of ED. The prevalence of ED was significantly higher in individuals aged 50 years and older (86.78%) and was associated with increased rates of hypertension, diabetes mellitus, and cardiovascular disease (P < 0.001). A J-shaped relationship was identified between RAR and ED risk. Specifically, the risk of ED significantly increased below the RAR threshold of 3.42 (OR = 3.01, 95% CI: 2.08-4.36, P < 0.001), while the risk plateaued at higher RAR values. Subgroup analyses revealed significant interactions with ethnicity (P = 0.018) and moderate-intensity physical activity (P = 0.004). Non-Hispanic whites (OR = 2.85) and individuals engaging in moderate-intensity activity (OR = 3.83) exhibited a heightened risk of ED. No significant interactions were observed for other variables, including age and BMI.
The results demonstrated that RAR was independently associated with ED risk, exhibiting a J-shaped relationship. There was a significant increase in risk below RAR = 3.42, with saturation occurring after exceeding this threshold.
Frontiers in endocrinology. 2025 Mar 25*** epublish ***
Yang Xu, Shuofeng Li
Department of Urology, Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China., Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.